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目的研究统计法运动单位数目估计(MUNE)技术在下运动神经元轴索变性和脱髓鞘疾病诊断中的价值。方法共收集41例肌萎缩侧索硬化(ALS)、25例获得性脱髓鞘疾病和48名健康对照,对正中神经/拇短展肌采用统计法MUNE技术进行测定,分析比较运动单位数目、表面记录的运动单位电位(SMUP)平均波幅、最大SMUP波幅以及刺激反应功能曲线在3组研究对象之间的特点。结果在ALS、脱髓鞘疾病和健康对照组,数目加权的运动单位数目分别为49±20、109±38、118±12,平均SMUP波幅分别为(121±51)、(58±33)、(110±25)μV,最大SMUP波幅分别为(263±150)、(107±74)、(139±36)μV,复合肌肉动作电位分别为(5.8±2.8)、(6.5±4.6)、(13.1±2.8)mV。与健康对照组比较,ALS组运动单位数目明显下降(P<0.01)、最大SMUP波幅明显增高(P<0.01);与健康对照组和ALS组比较,脱髓鞘组平均SMUP波幅明显下降(P<0.01),而运动单位数目、最大SMUP波幅与健康对照组差异无统计学意义。ALS组刺激反应功能曲线明显不规则,最大采样区间明显增大。结论ALS患者运动单位数目降低,最大SMUP波幅增高,刺激反应功能曲线上的最大采样区间增大;脱髓鞘患者平均SMUP波幅明显下降。在某些情况下,根据上述特点,可以将统计法MUNE技术作为一种无创的方法,来协助鉴别周围神经脱髓鞘和轴索损害。
Objective To study the value of statistical method of exercise unit number estimation (MUNE) in the diagnosis of axonal degeneration and demyelinating diseases in lower motor neurons. Methods A total of 41 cases of amyotrophic lateral sclerosis (ALS), 25 cases of acquired demyelinating disease and 48 healthy controls were collected. The median nerve/thalamus abductors muscle was measured using statistical MUNE technique, and the number of motor units was analyzed and compared. The surface-recorded motor unit potential (SMUP) mean amplitude, maximum SMUP amplitude, and stimuli response function curve were among the three groups of subjects. Results In ALS, demyelinating diseases, and healthy controls, the number-weighted motor units were 49±20, 109±38, and 118±12, respectively, and the mean SMUP amplitudes were (121±51) and (58±33), respectively. (110 ± 25) μV, the maximum SMUP amplitudes were (263 ± 150), (107 ± 74), (139 ± 36) μV, and the compound muscle action potentials were (5.8 ± 2.8), (6.5 ± 4.6), ( 13.1 ± 2.8) mV. Compared with the healthy control group, the number of exercise units in the ALS group was significantly decreased (P<0.01), and the maximum SMUP amplitude was significantly higher (P<0.01). Compared with the healthy control group and the ALS group, the average SMUP amplitude was significantly decreased in the demyelination group (P). <0.01), but there was no significant difference in the number of exercise units, the maximum SMUP amplitude and the healthy control group. The stimuli response curve of ALS group was obviously irregular, and the maximum sampling interval increased significantly. Conclusions The number of exercise units in ALS patients is decreased, and the maximum SMUP amplitude is increased. The maximum sampling interval on the stimuli response function curve is increased; the mean SMUP amplitude of demyelinated patients is significantly decreased. In some cases, according to the above characteristics, the statistical MUNE technique can be used as a non-invasive method to assist in the identification of peripheral nerve demyelination and axonal damage.